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See detailHydroxyethyl Starch 130/0.4 and the Risk of Acute Kidney Injury After Cardiopulmonary Bypass: A Single-Center Retrospective Study.
LAGNY, Marc-Gilbert ULg; ROEDIGER, Laurence ULg; KOCH, Jean-Noël ULg et al

in Journal of Cardiothoracic and Vascular Anesthesia (2015)

Hydroxyethyl Starches (HES) have been shown to increase the risk of acute kidney injury (AKI) in intensive care unit patients suffering sepsis. Whether this risk also applies to patients undergoing ... [more ▼]

Hydroxyethyl Starches (HES) have been shown to increase the risk of acute kidney injury (AKI) in intensive care unit patients suffering sepsis. Whether this risk also applies to patients undergoing elective surgery remains unclear. We investigated whether HES is associated with acute kidney injury after on-pump cardiac surgery. Materials and Methods: Balanced HES 130/0.4 (Volulyte®, Fresenius Kabi AG, Bad Homburg, Germany) was used as a pump prime and for intraoperative fluid therapy until July 2013 and has been entirely replaced by a balanced crystalloid solution (Plasmalyte®, Baxter, Lessines, Belgium) from August 2013. Data from 697 adult patients undergoing cardiac surgery between April 2013 and June 2014 were reviewed. HES patients were propensity-matched on previously published risk factors for AKI after cardiac surgery to patients treated with crystalloids. Postoperative AKI was defined as the primary outcome and assessed using the Acute Kidney Injury Network classification. A conditional logistic regression was used to investigate the association between the use of HES and postoperative AKI. Secondary outcomes included renal function at postoperative day 7, 30-day mortality, lengths of ICU and hospital stays and the incidence of postoperative respiratory complications. Results and Discussion: One hundred and thirty HES patients were successfully matched with 130 crystalloids patients. HES was significantly associated with postoperative AKI (odds ratio=2.4; 95 % CI= 1.2-4.8; P=0.02). No significant association was found between HES and any of the secondary outcomes. Conclusion: This study suggests that using balanced HES 130/0.4 as a pump prime and for intraoperative fluid therapy in adult patients undergoing on-pump cardiac surgery is associated with a higher incidence of AKI during the early postoperative period. [less ▲]

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See detailThe effect of intraoperative 6% balanced hydroxyethyl starch (130/0.4) during cardiac surgery on transfusion requirements.
HANS, Grégory ULg; Ledoux, Didiier; Roediger, Laurence et al

in Journal of cardiothoracic and vascular anesthesia (2015), 29(2), 328-32

OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative ... [more ▼]

OBJECTIVES: To compare transfusion requirements in adult cardiac surgery patients when balanced hydroxyethyl starches (HES) (130/0.4) or balanced crystalloids is used for pump prime and intraoperative fluid therapy. DESIGN: Data were obtained retrospectively from medical records and perfusion charts. Matching based on propensity scores was used to adjust for potential confounders. SETTING: A university hospital. PARTICIPANTS: Adult patients undergoing cardiac surgery with the use of cardiopulmonary bypass. INTERVENTIONS: Allocation to one of the study groups according to whether balanced HES or balanced crystalloids was used for pump prime and intraoperative fluid therapy. MEASUREMENTS AND MAIN RESULTS: 240 propensity-matched patients were retained for final analyses. Forty-eight patients (40%) of the colloid group and 28 patients (23.3%) of the crystalloid group received blood products, with an odd ratio (95% CI) of 2.1(1.2-3.8 (P=0.009). After bypass HES patients had lower hemoglobin levels (8.4 [1.3] gr/dL vs 9.6 [2] gr/dL; P<0.001) and a higher cumulative chest drain output after 3 hours (180 [210] mL vs 140 [100] mL, P<0.001]. Heparinase thromboelastogram (TEG(R)) showed longer K times (2.5[1.1] vs 1.6[0.8], P<0.001) and lower maximal amplitudes (55.1[12.5] vs 63.4[9.8], P=0.008). CONCLUSIONS: HES patients required more transfusions, owing to greater hemodilution, HES-induced clotting disturbances, and bleeding. [less ▲]

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See detailExtravasation of albumin after cardiopulmonary bypass in newborns.
Tassani, Peter; Schad, Hubert; Schreiber, Christian et al

in Journal of Cardiothoracic and Vascular Anesthesia (2007), 21(2), 174-178

OBJECTIVE: The systemic inflammatory response to cardiopulmonary bypass (CPB) possibly increases microvascular permeability to plasma proteins, leading to capillary leak syndrome. The study was conducted ... [more ▼]

OBJECTIVE: The systemic inflammatory response to cardiopulmonary bypass (CPB) possibly increases microvascular permeability to plasma proteins, leading to capillary leak syndrome. The study was conducted to elucidate any protein leakage in newborns using Evans blue dye as tracer. DESIGN: Prospective controlled study. SETTING: University-affiliated heart center. PARTICIPANTS: Eleven neonates with transposition of the great arteries. INTERVENTIONS: Plasma interleukin-6 (IL-6), IL-10, fractional escape rate (FER) of an intravenous bolus of Evans blue, and colloid osmotic pressure (COP) were assessed before and after surgery (statistics: median and 25th-75th percentile, Friedman's 2-way analysis of variance, and Wilcoxon matched-pairs signed-rank test [before and after surgery]). MEASUREMENTS AND MAIN RESULTS: All patients had an uneventful intraoperative course. The demographic and operative data were age 11 (10-13) days, body weight 3.2 (3.0-3.3) kg, CPB time 132 (123-144) minutes, and aortic cross-clamp time 66 (64-78) minutes. The proinflammatory IL-6 increased 60-fold and the anti-inflammatory IL-10 only 3-fold after CPB. FER, however, was not changed, whereas COP was significantly reduced after CPB. CONCLUSIONS: In contrast to the expectation, the escape rate of Evans blue, reflecting the extravasation of albumin, was not increased after CPB. However, reduced COP, hypothermia, and also a reduced lymphatic drainage may contribute to edema formation. The present data do not support the hypothesis of a capillary leak after CPB in newborns. [less ▲]

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